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Key takeaways
- CMS reports an initial six-month nationwide moratorium beginning May 13, 2026, with possible extensions.
- Some ownership changes can require initial enrollment under the majority-ownership rule.
- A transaction that depends on a new enrollment needs an explicit feasibility review.
What is the current status?
CMS put a nationwide pause on new Medicare enrollment for home health agencies and hospices on May 13, 2026. The pause covers initial enrollment forms. It also covers majority-ownership changes that require new enrollment and do not meet an exception. This article checked that page on September 6, 2026; the page was last modified August 27. (Source: CMS provider enrollment moratoria)
CMS announced an initial six-month period and allows extensions in further six-month periods. Do not promise a closing or sign a loan commitment based on a guessed end date. Even a short pause matters if the buyer needs to enroll as a new provider.
The companion FAQ was revised July 9, 2026. It adds important details about pending applications, new locations, some ownership transactions, and state programs. This guide follows that CMS guidance. Check the date when using it: a later notice could change what CMS allows.
Distinguish new enrollment from an existing provider
The pause does not mean every enrolled HHA or hospice must stop care or claims. CMS says these providers can generally stay in Medicare, bill for covered care, and make certain updates to their records. They must still meet their ongoing requirements. (Source: CMS moratorium FAQ, Q8 and Q13)
Ask whether CMS will treat the proposed change as new enrollment. Even a long-running business can face that issue. Review its recent ownership changes and how the buyer plans to handle the provider agreement.
| Proposed situation | Issue to verify before relying on the plan |
|---|---|
| New HHA or hospice initial enrollment | Whether the moratorium requires denial of the application |
| Majority change within the relevant 36-month period | Whether new enrollment is required and an exception applies |
| Buyer declines the existing provider agreement | Consequences of becoming an initial applicant |
| Continuing enrolled operation | Ongoing compliance and any separately regulated changes |
| Previously received application | Evidence that the contractor received it before implementation |
| New branch or additional location | The July FAQ's restriction on new practice locations |
Use these questions to plan the review. They do not show that a deal is approved. For each question, find the facts and the authority that decides it. An exemption from one rule does not approve the whole deal.
Why an ownership change can require initial enrollment
Under 42 CFR 424.550, certain majority-ownership changes within 36 months of initial Medicare enrollment or the most recent majority change require new enrollment. The rule includes specified exceptions. When new enrollment is required, the old agreement and billing rights do not pass to the new owner. (Source: 42 CFR 424.550)
The 36-month rule guide explains direct ownership, cumulative changes, relevant dates, and exception records. The age of the legal entity does not settle that question. Calling the deal a stock sale does not settle it either. A prior exempt majority change can also matter to the next ownership period.
The moratorium and the 36-month rule perform different jobs. An exception to the ownership rule can affect whether initial enrollment is required. It is not an individual waiver of a moratorium that otherwise applies. Record each finding separately in the deal file. (Source: CMS Program Integrity Manual, section 10.6.1.1.5; CMS moratorium FAQ, Q6 and Q11)
Review assignment before choosing to reject the agreement
CMS-855A says a purchaser that declines the existing provider agreement becomes an initial applicant and the old agreement should terminate. A buyer may want to avoid the old owner's debts. But refusing the agreement does more than shift risk between the parties. (Source: CMS-855A, September 2024 revision)
Ask counsel what this choice means before using it in the closing plan. Can the buyer enroll and legally operate? How will patient care and funding continue? The CHOW guide explains the agreement and application questions. Section 489.18's assignment framework should be read with the applicable enrollment guidance. (Source: 42 CFR 489.18)
No purchase agreement, indemnity, or interim-management label creates permission to use a Medicare number outside the applicable rules. If the plan depends on current billing, show the evidence for it. State what happens if that assumption is wrong.
Separate a new location from a move or existing location
The July CMS FAQ says the moratorium prohibits adding a new practice location to an existing HHA or hospice enrollment. That includes new branches, satellite offices, and sites added to expand the business. Being enrolled does not mean every plan to grow is allowed. (Source: CMS moratorium FAQ, Q10)
The same FAQ distinguishes locations already recognized and certified by Medicare that transfer in qualifying acquisitions or mergers. It says enrolled providers can acquire or merge with other enrolled providers when no CIMO requires new enrollment and no new locations are being added. Check the actual providers and sites against both conditions.
The single-branch purchase exercise compares a fictional local asset package with the parent’s support chart. The records describe current arrangements but leave the future team unresolved. Use the comparison to identify what the package excludes. Then connect the proposed operator and location with the separate enrollment review.
A move is not always just a change of address. CMS or the state survey agency must assess whether the move changes the operation in a substantive way. Verify the treatment before signing a new lease or relying on a move in the forecast. (Source: CMS moratorium FAQ, Q9)
| Location evidence | Reason to gather it |
|---|---|
| Existing enrollment and certification records | Establish which locations are already recognized |
| Before-and-after location list | Identify additions, transfers and relocations |
| Services at each site | Assess whether the operating scope changes |
| Proposed acquisition or merger structure | Connect location treatment with ownership treatment |
| Agency or contractor correspondence | Preserve the actual review and unresolved conditions |
Do not describe an existing-location acquisition as an automatic way around the restriction. Other licensing, enrollment, contract, and operating requirements still need to be satisfied. Show how the proposed deal meets the stated conditions.
Preserve receipt evidence for pending applications
CMS says the moratorium does not apply to an enrollment application received by the Medicare contractor before the date it was imposed. Find proof of when the contractor received it. A date on a signed form, a check, or a business filing does not prove receipt. (Source: CMS moratorium FAQ, Q12)
Keep the filing, proof of receipt, case details, and later letters together. Ask the contractor how any material change or additional request affects the actual application. Do not assume that an earlier filing protects every later proposal associated with the same business name.
An earlier receipt date does not prove that a filing is complete or can be approved. Other screening, licensing, survey, and program requirements remain relevant. A buyer should distinguish a pending application from an approved provider when assessing the target.
Understand denial, appeals and later applications
The CMS FAQ says affected initial applications submitted during the moratorium will be denied. They must be resubmitted after the restriction is lifted. The FAQ does not promise a place in line or approval after six months. (Source: CMS moratorium FAQ, Q13)
CMS also says there are no individual provider or supplier exceptions to the moratorium. An appeal can address whether the pause applies to that provider. Counsel should assess any available process on the actual facts; this article does not promise an appeal outcome. (Source: CMS moratorium FAQ, Q6)
Continue required reporting and revalidation for an existing enrolled provider. The pause affects new enrollment. Providers still have their other duties while they discuss a sale.
Check Medicaid, CHIP and state licensing separately
CMS’s July FAQ allows states to decide whether a home health or hospice moratorium is appropriate for their Medicaid or CHIP programs and what scope it should have. The Medicare pause does not, by itself, bar Medicaid enrollment or state licenses across the country. (Source: CMS moratorium FAQ, Q14)
Identify each target's actual payer and license arrangements. A Medicare conclusion may leave separate questions about state enrollment, managed-care contracts, permitted service areas, or the proposed operator. Record the rule and the authority in charge of each decision. Do not call them all one approval.
Connect uncertainty to the offer and cash plan
Before relying on a closing date, prepare an enrollment and location decision record. List the provider identity, ownership chronology, proposed agreement treatment, locations, application status, and supporting evidence. Show which conclusions are confirmed and which remain assumptions.
The license-value buyer guide connects this feasibility review with the offer. Its fictional buyer cannot restore an unsupported operating case merely by removing a requested license premium. First identify the rights the proposed transaction can support, then decide which price and revenue assumptions still apply.
Ask counsel how the unresolved issues affect the sale terms and loan conditions. The financial plan should separately address payroll, operating expenses, collections, and the cost of delay. Use the working-capital guide to frame those questions without assuming that every future receipt arrives on time.
Continue the home-health or hospice diligence review while the ownership path is assessed. A workable enrollment route is only one part of the review. Check the earnings, quality of care, staff, and price as well.
The home-health purchase example places a proposed branch beside three other fictional changes to support, supervision and care. An answer about enrollment leaves those other reviews distinct. Use the comparison to identify open assumptions. The whole buyer plan needs more support than an answer about one proposed location.
Common mistakes to avoid
- Assuming that every existing agency or every acquisition is blocked.
- Assuming that every existing provider can add a branch or move without review.
- Treating an affected application as a place in a queue.
- Confusing a 36-month exception with an individual moratorium waiver.
- Treating Medicare, Medicaid, CHIP, and state licenses as one program.
- Promising that a future date guarantees enrollment will reopen.
Sellers can gather their Medicare records and ownership history before marketing. Buyers can ask for evidence that the deal can proceed before spending heavily on later review. Both should recheck current CMS guidance when the facts, dates, or proposed locations change.
For the basic term, the moratorium definition shows why an existing-site acquisition and a proposed new branch need separate conclusions. Keep their forecast revenue and unresolved permissions separate as the transaction develops.
The interim-management definition helps review a temporary role alongside the actual approval path. A management agreement’s label does not resolve billing authority, ownership reporting or the moratorium questions described here.
The early home-health sale example compares initial enrollment with a later majority-ownership change. Keep that chronology beside the moratorium review before promising that a buyer can continue the Medicare operation.
Frequently asked questions
Does the moratorium stop every existing agency from operating?
No. CMS distinguishes initial enrollment from existing providers, which generally may continue Medicare participation and covered claims while meeting applicable requirements. It does not suspend their reporting, revalidation or other compliance duties.
Are all home health and hospice acquisitions blocked?
No. The actual ownership and enrollment path matters. Non-exempt majority changes requiring initial enrollment are affected. CMS also addresses qualifying acquisitions and mergers involving existing enrolled locations. Obtain a transaction-specific review rather than assuming that every sale has the same result.
Can I add a new branch during the moratorium?
The July 9 CMS FAQ says the moratorium prohibits adding a new practice location, including new branches, satellite offices and expansion locations. It separately addresses existing certified locations transferred through qualifying acquisitions or mergers.
What if the contractor received the application before May 13?
CMS says the moratorium does not apply to an enrollment application received by the Medicare contractor before the moratorium was imposed. Preserve the receipt evidence. This does not mean the application meets every other requirement or will be approved.
Will an affected application simply wait until the moratorium ends?
No. CMS says affected initial applications submitted during the moratorium will be denied and must be resubmitted after it is lifted. Do not treat submission as a place in an approval queue.
Can a provider obtain an individual hardship exception?
The CMS July FAQ says individual provider or supplier exceptions to the moratorium are not permitted. It describes a limited appeal over whether the moratorium applies. That is different from the specified exceptions to the 36-month ownership rule.
Does the nationwide Medicare rule automatically apply to Medicaid?
No. CMS’s FAQ leaves states to decide whether and how to impose HHA or hospice moratoria for their Medicaid and CHIP programs. Check the actual state program and licensing requirements separately.
Can I assume enrollment will reopen after six months?
No. CMS announced an initial six-month period and may extend it in six-month increments. Check the latest notices before relying on a future enrollment or closing date. The website review date is not a prediction of when the restriction will end.
Sources
Sources are dated to distinguish current guidance from earlier publications. They support the identified facts; the transaction questions and examples are educational analysis.
- CMS: provider enrollment moratoria (2026). Retrieved September 5, 2026.
- CMS: home health and hospice moratorium FAQs (2026). Retrieved September 5, 2026.
- eCFR: 42 CFR 424.550 (2026). Retrieved September 5, 2026.
- eCFR: 42 CFR 489.18 (2026). Retrieved September 5, 2026.
- CMS: institutional-provider enrollment application CMS-855A (2024). Retrieved September 6, 2026.
- CMS Program Integrity Manual: CHOW and HHA/hospice ownership (2025). Retrieved September 6, 2026.